Resultados del abordaje laparoscópico en el tratamiento de la obstrucción aguda del intestino delgado por adherencias y hernias internas / Results of a laparoscopic approach for the treatment of acute small bowel obstruction due to adhesions and internal hernias

Introducción La laparotomía suele ser la vía de abordaje de elección en los casos de intervención quirúrgica por obstrucción aguda de intestino delgado (OAID).Pacientes y métodos De febrero 2007 hasta mayo 2012 se registraron prospectivamente los pacientes intervenidos de urgencias en nuestro centro vía laparoscópica por OAID por adherencias (27 casos) y/o hernia interna (6 casos). Todos disponían de una TC preoperatoria. Se excluyeron del abordaje laparoscópico aquellos con peritonitis y/o sepsis. En caso de requerir resección intestinal se convirtió a laparotomía. Resultados La edad media de los 33 pacientes operados fue de 61,1 ± 17,6 años. El 64% tenían antecedentes de cirugía abdominal previa. El 72% de los casos fue operado por un cirujano experto en laparoscopia. La tasa de conversión fue del 21%. El tiempo operatorio y estancia postoperatoria medios fueron de 83 ± 44 min y 7,8 ± 11,2 días, respectivamente. El tiempo operatorio (72 ± 30 vs 123 ± 63 min), día de inicio de ingesta oral (1,8 ± 0,9 vs 5,7 ± 3,3 día) y estancia postoperatoria (4,7 ± 2,5 vs 19,4 ± 21 días) fueron significativamente menores en el grupo laparoscopia respecto al de conversión, si bien los pacientes convertidos presentaron mayor gravedad clínica (2 resecciones intestinales). Hubo 2 complicaciones graves (Clavien-Dindo III y V ) en el grupo de conversión. Conclusiones El abordaje laparoscópico, en casos seleccionados de OIDA por adherencias y hernias internas, cuando es realizado por cirujanos entrenados en laparoscopia, presenta una alta probabilidad de éxito (baja tasa de conversión, corta estancia postoperatoria y baja morbilidad), por lo que su uso estaría plenamente justificado en estos casos (AU)

Introduction Laparotomy is the standard approach for the surgical treatment of acute small bowel obstruction (ASBO).Patients and methods From February 2007 to May 2012 we prospectively recorded all patients operated by laparoscopy in our hospital because of ASBO due to adhesions (27 cases) and/or internal hernia (6 cases). A preoperative abdominal CT was performed in all cases. Patients suffering from peritonitis and/or sepsis were excluded from the laparoscopic approach. It was decided to convert to laparotomy if intestinal resection was required. Results The mean age of the 33 patients who underwent surgery was 61.1±17.6 years. 64% had previous history of abdominal surgery. 72% of the cases were operated by surgeons highly skilled in laparoscopy. Conversion rate was 21%. Operative time and postoperative length of stay were 83±44 min and 7.8±11.2 days, respectively. Operative time (72±30 vs 123±63 min.), tolerance to oral intake (1.8±0.9 vs 5.7±3.3 days) and length of postoperative stay (4.7±2.5 vs 19.4±21 days) were significantly lower in the laparoscopy group compared with the conversion group, although converted patients had greater clinical severity (2 bowel resections). There were two severe complications (Clavien-Dindo III and V) in the conversion group. Conclusions In selected cases of ASBO caused by adhesions and internal hernias and when performed by surgeons highly skilled in laparoscopy, a laparoscopic approach has a high probability of success (low conversion rate, short stay in hospital and low morbidity); its use would be fully justified in these cases (AU)

Results of a laparoscopic approach for the treatment of acute small bowel obstruction due to adhesions and internal hernias.

INTRODUCTION: Laparotomy is the standard approach for the surgical treatment of acute small bowel obstruction (ASBO). PATIENTS AND METHODS: From February 2007 to May 2012 we prospectively recorded all patients operated by laparoscopy in our hospital because of ASBO due to adhesions (27 cases) and/or internal hernia (6 cases). A preoperative abdominal CT was performed in all cases. Patients suffering from peritonitis and/or sepsis were excluded from the laparoscopic approach. It was decided to convert to laparotomy if intestinal resection was required. RESULTS: The mean age of the 33 patients who underwent surgery was 61.1 ± 17.6 years. 64% had previous history of abdominal surgery. 72% of the cases were operated by surgeons highly skilled in laparoscopy. Conversion rate was 21%. Operative time and postoperative length of stay were 83 ± 44 min. and 7.8 ± 11.2 days, respectively. Operative time (72 ± 30 vs 123 ± 63 min.), tolerance to oral intake (1.8 ± 0.9 vs 5.7 ± 3.3 days) and length of postoperative stay (4.7 ± 2.5 vs 19.4 ± 21 days) were significantly lower in the laparoscopy group compared with the conversion group, although converted patients had greater clinical severity (2 bowel resections). There were two severe complications (Clavien-Dindo III and V) in the conversion group. CONCLUSIONS: In selected cases of ASBO caused by adhesions and internal hernias and when performed by surgeons highly skilled in laparoscopy, a laparoscopic approach has a high probability of success (low conversion rate, short hospital length of stay and low morbidity); its use would be fully justified in these cases.